Forecasting the future may not quite gel with the evidence-informed approach at Science-ish, but it’s the time of year for breaking rules. With cautious certainty, here are seven trends in health you’ll hear more about in 2013—and beyond:
1. More ‘reverse innovation’
Most health-care innovation only marginally improves existing technology while it costs a lot more. During a recent Toronto talk, the CEO of Grand Challenges Canada, Dr. Peter Singer, argued that health innovation must focus on the “cost” part of the equation. He’s right, and as governments grapple with a flagging global economy, Science-ish expects it’s a refrain you’ll hear a lot in 2013. Related to this idea is the potential of “reverse innovation” or importing cost-effective technologies and systems from low- and middle-income countries to the industrialized world. (Eye clinics in Asia that offer quality but cut-rate cataract surgeries, for example, or low-cost digital X-rays for tuberculosis screening in India that could be used in remote communities here.) Incorporating these ideas will require getting past vested interests, which will always be tricky—unless a troubled economic climate forces change.
2. Health in the palm of your hand:
In Kenya, mobile-phone bar codes are being used to track the vaccination of children (in exchange for free seeds and other agricultural inputs). In Bangladesh, researchers are working with cellphone companies to create immunization reminders. Text-message alerts are being used around the world to help HIV patients manage their treatment. Diagnosis is moving from the hospital into the community through mobile devices, and tech companies are vying to bring to market hand-held devices that patients could use to check for a range of diseases. These new technologies provide patients with access to information and the ability to manage their own data. Such tools challenge the medical establishment and the organization of health care, so this democratization will not happen over night.
3. Rise of the doctor war:
As cash-strapped governments rein in health spending and new doctors graduate from medical schools in record numbers, physicians and surgeons will see restrictions on the growth of their incomes—and they will react with militant ardor. In Canada, doctors unions usually negotiate their pay every four years with provincial governments, and lately, they aren’t doing so well. We’ve already seen relations heat up between the doctors and the province of Ontario this year when the Ontario Medical Association threatened a charter challenge. In Alberta, futile negotiations have been dragging on for almost two years. So what does this all mean? We may see doctors break from provincial associations to form their labour groups according to specialty (already a reality in Quebec). We may see doctors slowly lose their political power as governments invest less in them and more in other health-care providers. Worst of all, we may see doctors quit Canada for greener pastures (though this is less likely, especially when other pastures are not looking very fertile).
4. Crowd research:
During the next few years, we’ll see if the wisdom of crowds emerges when it comes to directing and funding scientific research. In 2012, the iCancer campaign launched with the aim of crowd-funding a trial to test a new treatment for neuroendocrine cancer, the kind that killed Steve Jobs. Researchers told the Guardian that they turned to the people after failing to secure support from big pharma. At St. Michael’s Hospital in Toronto and the University of Calgary, patients, caregivers and researchers work together to identify the research priorities of people on dialysis. The aim is to get input from those whose lives hinge on work in the lab. The year 2013 will surely bring more such innovation.
5. Shifting screening mores:
The cancer screening debates heated up again in 2012. The scientific community now recommends against routine PSA testing for prostate cancer in men, and that for women, while diagnostic mammography can be helpful, mass screening is not as effective as was once believed. As more robust evidence emerges and guidelines shift, expect to hear more about the public-health challenge of communicating shifting mores to patients. Right now, the conversation goes something like this: Doctor: “Ms. Green, new guidelines recommend you no longer need a mammogram every year.” Ms. Green: “Really? Please, give me one anyway.” This isn’t sustainable.
6. Slow medicine:
“Only 11 per cent of 3,000 health interventions have good evidence to support them. … A third of the activity in the U.S. health system produces no benefit. … Half of all angioplasties are unnecessary. … Four-fifths of new drugs are copies of old drugs,” and so begins a recent blog post on the British Medical Journal website by the former BMJ editor Richard Smith. He argues that the world must wake up and realize “medicine is far from being an exact science” and what we need now is more “slow medicine”—thoughtful, considered and evidence-informed. This seems particularly apt at a time when we are learning more about the problems with research for pharmaceuticals, and patients are expected to be more proactive and engaged in health care. If the slow food movement was a response to the mass production and degradation of the food on our dinner plates, slow medicine may gain momentum as more people learn that what’s in their pharmacies and hospitals is not be as pure or potent as they once believed.
7. Evidence revival:
Science-ish has argued that the ideals of evidence-based medicine must spread beyond the medicine cabinet and bedside. And Science-ish is only one voice in an international chorus calling for more evidence-informed policy, which the New Statesmen just declared is “enjoying a revival.” Though striking the right balance among values, politics and science is no easy task, when there are fewer resources, there will be less space for policies that don’t work. Let 2013 be the year of the evidence nerd.
Science-ish is a joint project of Maclean’s, the Medical Post and the McMaster Health Forum. Julia Belluz is the senior editor at the Medical Post. Got a tip? Seen something that’s Science-ish? Message her at firstname.lastname@example.org or on Twitter @juliaoftoronto
Thursday, December 27, 2012